免疫球蛋白G型抗环瓜氨酸肽抗体在原发性干燥综合征患者血清中的检出率及其意义

Prevalence and significance of immunoglobulin G-anti-cyclic citrullinated peptide antibodies in primary Sjgren's syndrome patients

目的：探讨免疫球蛋白G（immunoglobulin G， IgG）型抗环瓜氨酸肽（cyclic citrullinated peptides， CCP）抗体在原发性干燥综合征（primary Sjogren’s syndrome，PSS）患者中的检出率及其在PSS中的意义。方法：选取2006年3月至2009年12月在包头医学院第一附属医院确诊的PSS患者120例，用酶联免疫吸附试验（ enzyme-linked immunosorbent assay ， ELISA ）定量测定患者血清中的 IgG 型抗 CCP 抗体，免疫印迹法检测抗干燥综合征 A （Sjogren’s syndrome type A，SSA）抗体和抗干燥综合征B（Sjogren’s syndrome type B，SSB）抗体，魏氏法检测红细胞沉降率（erythrocyte sedimentation rate， ESR），免疫比浊法检测C反应蛋白（C reactive protein， CRP）、免疫球蛋白A （ immunoglobulin A ， IgA）、IgM、IgG和IgM型类风湿因子（ rheumatoid factor ， RF）的水平，同时观察患者临床症状和重要脏器受累情况；对上述患者定期随访3年，观察其进展为类风湿关节炎（rheumatoid arthritis， RA）的情况。结果：（1）抗CCP抗体在PSS患者中的检出率为19．17％；（2）随访3年，抗CCP抗体阳性患者比阴性患者更容易进展为RA （χ2＝5．015，P＝0．022）；（3）抗CCP 抗体阳性患者比阴性患者更容易出现关节受累（χ2＝8．058，P＜0．05），肿胀关节更多（U＝152．00，P＜0．05），晨僵持续时间更长（U＝100．00，P＜0．05），但两组患者重要脏器受累的比例相当（χ2分别为0．208、0．099、0．000、0．122，P＞0．05）；（4）抗CCP抗体阳性患者与阴性患者比较，抗SSA、SSB抗体的阳性率无明显差别（χ2分别为0．008、0．560，P＞0．05）；（5）多重线性回归显示，PSS患者抗CCP抗体的水平与IgM型RF水平呈正相关（B＝0．61，95％CI＝0．36～0．86， P＜0．05），而与ESR、CRP、IgA、IgM及IgG等水平无明显的相关性（P＞0．05）；（6）抗CCP抗体阳性患者与阴性患者比较，ESR、CRP、IgA、IgM及IgG水平的差异无统计学意义（P＞0．05），但抗CCP抗体阳性组IgM 型RF水平明显高于阴性组（U＝623．50， P＜0．05）。结论： IgG型抗CCP抗体在PSS中的阳性率为19．17％，与PSS患者关节受累相关，且抗CCP抗体阳性的患者更容易进展为RA。

Objective：To investigate the prevalence and significance of IgG-anti-cyclic citrullinated pep-tides （CCP） antibody in PSS patients .Methods：A total of 120 patients diagnosed with PSS were investi-gated in the first affiliated hospital of Baotou Medical College from March 2006 to December 2009.IgG-anti-CCP antibody was assayed by enzyme-linked immunosorbent assay （ELISA）, also anti-Sjogren’s syn-drome type A （ SSA） and Sjogren’ s syndrome type B （ SSB） antibody were assayed by immunoblotting . Erythrocyte sedimentation rate （ ESR ） was assayed by westergren in serum , and C reactive protein （CRP）, IgA, IgM, IgG and IgM-RF were detected by immune turbidimetric .At the same time, clinical symptoms and involvement of important organs were observed .Following up the patients above 3 years, the primary Sjogren’ s syndrome （ PSS） patients who had progressed to rheumatoid arthritis （ RA） were evaluated .Results：The positive rate of anti-CCP antibody in the PSS patients was 19 .17%; After 3 years, more patients who were positive for anti-CCP antibody had progressed to RA （χ2 =5.015,P=0.022） than the patients in negative group;The patients in anti-CCP antibody positive group were more prone to joint involvement （χ2 =8.058,P〈0.05）, more swollen joints （U=152.00,P〈0.05） and longer morning stiffness （U=100.00,P〈0.05） than the patients with negative anti-CCP antibody, but the involvement of vital organs in the two groups had no significant difference （χ2 =0.208,0.099,0.000 and 0.122,P〉0.05）; The positive rate of anti-SSA and SSB antibody in anti-CCP antibody positive group and negative group had no significant difference （χ2 =0.008 and 0.56,P〉0.05）;Multiple linear regression showed that the level of anti-CCP antibody was positively correlated with IgM-RF levels in the PSS patients （B=0.61, 95%CI =0.36 -0.86, P〈0.05）, but had no significant correlation with ESR, CRP, IgA, IgM and IgG levels （P〉0.05）.There were no significant differences in the level of ESR, CRP, IgA, IgM and IgG between anti-CCP antibody positive group and negative group （ P 〉0.05）, but the level of IgM-RF in anti-CCP antibody positive group was significantly higher than that in the negative group （U=623.50, P〈0.05）.Conclusion：Positive rate of IgG-anti-CCP antibody in PSS is 19 .17%, also it is associated with joint involvement and more prone to progressing to RA .